Study of Acid Reflux Therapy for Children with Asthma

儿童哮喘胃酸反流治疗研究

• 批准号: 7288749
• 负责人: Janet T. Holbrook
• 金额: $ 45.37万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-20 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7288749
• 关键词: Acids; Adrenal Cortex Hormones; Adverse event; Age-Years; Agonist; Asthma; Breathing; Bronchial Spasm; CYP2C19 gene; Child; Clinical; Clinical Trials Data Monitoring Committees; Communication; Cytochrome P450; Data; Data Analyses; Data Collection; Data Coordinating Center; Disease; Documentation; Dose; Electronics; Esophageal; Frequencies; Gastric Acid; Gastroesophageal reflux disease; Genetic Polymorphism; Grant; Healthcare; Hour; Inflammatory; Informed Consent; Interleukin-1 beta; Interview; Label; Lansoprazole; Lead; Leadership; Manuals; Masks; Measures; Monitor; Online Systems; Operative Surgical Procedures; Outcome Measure; Participant; Pathway interactions; Patients; Performance; Pharmaceutical Preparations; Placebos; Plasma; Procedures; Production; Protocols documentation; Proton Pump Inhibitors; Publications; Random Allocation; Randomized; Randomized Clinical Trials; Reflux; Reporting; Research Ethics Committees; Research Infrastructure; Research Personnel; Respiratory physiology; Score; Severities; Site; Subgroup; Symptoms; System; Testing; Training; Variant; airway inflammation; base; cytokine; data management; design; diaries; follow-up; knowledge base; quality assurance; response; symposium; web based interface

DESCRIPTION (provided by applicant): Gastroesophageal reflux (GER) is frequent in children with asthma, can induce bronchospasm, and increase airways reactivity. Children with asthma are often treated for GER with drugs to suppress gastric acid production. However, this treatment is expensive, and with unproven benefit. The primary objective in this proposal is to conduct a multi-site, randomized, clinical trial to test the hypothesis that treatment of GER with lansoprazole, an approved proton pump inhibitor, will decrease the frequency of exacerbations in children with poorly controlled asthma. The study will include 300 asthmatic children treated with inhaled corticosteroids, 6-16 years of age, with poor control defined by frequent symptoms, excessive beta agonist use, or frequent exacerbations. Participants will be randomly assigned to treatment with either lansoprazole or placebo for six months. The presence, severity, and relationship of GER to asthma symptoms will be determined with 24 hour esophageal pH monitoring, but randomization to treatment will not be influenced by the presences or severity of GER. The primary outcome measure is the proportion of participants who have exacerbations of asthma defined by diaries and interviews. Secondary outcome measures include asthma symptom and control scores, GER symptoms, lung function, and unscheduled health care contacts. Pre-defined subgroup analyses will examine the relationship between specific clinical features and the response to lansoprazole. Treatment response will also be evaluated with 3-hour post-dose plasma lansoprazole concentrations, and related to polymorphisms in CYP2C19, the cytochrome P450 pathway, and IL-1 beta, a pro-inflammatory cytokine. Tertiary studies will determine how the magnitude of GER impacts airways inflammation, as measured by the concentrations of H+ (pH) and NO in expired breath. The results of this trial should have a major impact on the understanding and treatment of GER in children with asthma.

描述（由申请人提供）： 胃食管反流（格尔）是哮喘儿童常见的并发症，可引起支气管痉挛，增加气道反应性。患有哮喘的儿童经常用抑制胃酸产生的药物治疗格尔。然而，这种治疗是昂贵的，并且没有证实的好处。本提案的主要目的是进行一项多中心、随机化临床试验，以检验以下假设：兰索拉唑（一种获批的质子泵抑制剂）治疗格尔将降低哮喘控制不佳儿童的急性发作频率。该研究将纳入300名接受吸入性皮质类固醇治疗的哮喘儿童，年龄6-16岁，控制不佳，定义为频繁症状，过度使用β激动剂或频繁加重。受试者将被随机分配接受兰索拉唑或安慰剂治疗6个月。格尔的存在、严重程度以及与哮喘症状的关系将通过24小时食管pH监测来确定，但治疗的随机化不受GER的存在或严重程度的影响。主要结局指标是通过日记和访谈确定的哮喘急性发作的参与者比例。次要结局指标包括哮喘症状和控制评分、格尔症状、肺功能和计划外的医疗保健接触。预定义的亚组分析将检查特定临床特征与兰索拉唑应答之间的关系。 还将使用给药后3小时血浆兰索拉唑浓度评价治疗反应，并与CYP 2C 19（细胞色素P450途径）和IL-1 β（一种促炎细胞因子）的多态性相关。三级研究将确定格尔的程度如何影响气道炎症，如通过呼气中H+（pH）和NO的浓度所测量的。 这项试验的结果应该对哮喘儿童格尔的理解和治疗产生重大影响。